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‘Freedom for the many will mean seclusion for the few’, Dr Bhatti says, outlining new ‘test, track and isolate’ strategy

An aggressive strategy to "test, track and isolate” positive cases of Covid-19 will mean that as Gibraltar eases lockdown restrictions in coming weeks and months, many people in the community will still be required to self-isolate in order to protect others.

Dr Sohail Bhatti, the Direct of Public Health, said the price of greater freedom would be continued lockdown for anyone who tests positive, and for those they have come into contact with.

The strategy is complex and multi-faceted, and the details and infrastructure are still being finalised before they can be implemented.

But the message was clear.

“The price of the freedom of the many is the seclusion of the few whilst they are infected,” Dr Bhatti said.

He was speaking at the daily 4pm press conference at No.6 Convent Place, where he offered additional details on how the Gibraltar Health Authority will “spot, seek and seclude” anyone who has tested positive or has had “intense” contact with anyone with the virus.

It will involve detailed questioning of all positive cases - it could take “two hours or more” - to establish where they have been and who they have been in contact with.

In time, the government also hopes to support this with technology including contact-tracing apps able to identify through data the movements and contacts of people with the virus.

The aim is to identify anyone genuinely at risk. Dr Bhatti described it as "one degree of freedom", meaning people that a positive person has been in direct contact with for more than 15 minutes within a particular distance.

Often that will mean people in the same household or workplace.

The task presents a huge challenge because it involves not just quizzing people with the virus to identify persons at risk, but also maintaining records of those details and acting on that information, and following up on those contacts. 

And it will come with a new development because once the system is up and running, anyone who comes into "intense" contact with someone who has tested positive will be asked to self-isolate for two weeks.

Until now, the requirement for self-isolation has been focused primarily on those who have actually tested positive.

But this early strategy has only proved successful because of the general lockdown. Once restrictions in different areas are eased over the coming weeks and months, the requirements for self-isolation will be stepped up wherever cases are detected.

"If we have a passive system which allows everyone else to just wander around, then what we are doing is effectively enabling the fuel for this virus to spread," Dr Bhatti said.

"That means that people who are deemed to have been in contact [with a positive person] will be advised to isolate too."

"That will also mean that, at any one time, there will be a proportion of our people who will be self-isolating because they have been in contact."

"The purpose of that is not to prolong the agony, it is to protect everyone else."

"The price of loosening up will be that we will be much more aggressive in seeking and destroying this virus where we find it."

As a first step, the GHA is preparing to introduce two tandem forms of screening.

The first step will be to systematically screen frontline workers in key areas ranging from healthcare to law enforcement and others, including teachers, who have multiple direct contact with members of the public.

The strategy aims to find the virus, stamp it out and limit the spread of infection at a time when its prevalence in the community is relatively low.

Part of the strategy will mean that anyone tested will have to isolate even while awaiting the results of the test, placing greater focus on the GHA's in-house testing to ensure a fast turnaround and avoid people having to stay at home unnecessarily.

"The faster that test comes back, the quicker and easier you are going to be able to go back to your normal business," Dr Bhatti said.

In parallel, the GHA will also screen people whose job potentially puts them in contact with the most vulnerable people in the community, be they elderly residents over the age of 70 or those with underlying medical conditions that heighten risk.

The GHA aims to screen one in seven members of the frontline workforce in any one week as part of this rolling targeted programme.

"That means that every seventh week it will be your turn," Dr Bhatti said, adding that this will help managers in each service to accommodate the potential for workers to be absent if required to self-isolate.

"In terms of the targeted population [meaning those who work with vulnerable people], we think the best compromise we can come up with is one week in four."

The frequency of the screening will in large part be determined by laboratory capacity and turnaround times for tests, not just with the laboratory here, but also facilities in Spain that the GHA has used over the past few weeks. The availability of swabs, "which is not infinite”, will also be a determining factor.

Dr Bhatti said the screening will not be optional but that officials hope an appeal to civic duty will rule out the need for legislation, adding that “it makes no sense” if some people are able to avoid being swabbed.

"My fear is that the people who do not want to get swabbed may be the very super spreaders [who are positive but have no symptoms] that we need to capture,” he said.

"We can't beat out a fire if we still have a little spark in the corner."

The Director of Public Health said that forecasting the spread of Covid-19 in Gibraltar is "incredibly difficult" because it involves predicting what will happen in the next week to a fortnight, which is the incubation period for the virus.

The virulence of Covid-19 means that if the calculations are off, the result is a spike in cases by which time it is too late to contain without extreme measures.

In practice, as Gibraltar moves into the phase of easing restrictions, it will mean close monitoring of the situation, ensuring a good margin of error and, potentially, the reintroduction of restrictions if necessary.

The decision will be based on a set of criteria, or triggers, that public health analysts are still working out and fine-tuning.

"What has happened in Gibraltar is that we have taken action ahead of time, and that's served us well so far," Dr Bhatti said.

"So we will do the same when it comes to setting those triggers."

"We want to make sure those triggers have enough margin to enable us either to step back, or to tighten up a little bit more."

Dr Bhatti said Gibraltar had been kept safe to date through social distancing and an early lockdown.

"The point is, we've got to have a change to be able to do it because it takes two weeks for a lockdown to take effect," he added.

"So in the same way that I've got to predict when the triggers are, I've got to predict them two weeks in advance."

"So the [infection numbers] may look quite low, but that's why I'm doing it."

Albert Isola, the Minister for Digital and Financial Services, said the strategy involved “a marathon, not a sprint”.

And while the government was poised to announce a range of measures that would enable some sectors of the economy affected by the lockdown to return to work in the coming days, he cautioned against any over-eager rush to exit.

"With all this talk of easing lockdown, we are not through this by any stretch of the imagination," Mr Isola said.

"I ask you to follow the advice, maintain social distancing, keep washing your hands and stay safe."